Treatment Options for Temporomandibular Joint (TMJ) Disorders

First-Line Conservative Approaches

The American College of Physicians recommends jaw exercises and stretching as they provide significant pain relief and functional improvement, approximately 1.5 times the minimally important difference in pain reduction 1
Manual trigger point therapy is strongly recommended as it provides one of the largest reductions in pain severity 1, 2
Cognitive behavioral therapy (CBT), with or without biofeedback or relaxation techniques, provides substantial pain reduction 1, 2
Patient education about avoiding aggravating activities, maintaining a soft diet, and applying heat/cold therapy reduces pain and inflammation 1
NSAIDs are recommended for pain relief and to reduce inflammation 1, 2

NSAIDs are first-line medications for pain and inflammation 1
Muscle relaxants may help overcome muscle spasm when other approaches fail 1
Neuromodulatory medications (e.g., amitriptyline, gabapentin) can be considered for chronic TMJ pain 1, 2
Combining NSAIDs with opioids is strongly recommended against due to increased risks without clear additional benefits 1, 2

For TMJ arthritis, a trial of scheduled NSAIDs is conditionally recommended as part of initial therapy 3, 1
Intra-articular glucocorticoid injections may be considered for TMJ arthritis but should be used sparingly and preferably in skeletally mature patients 3, 1
Conventional synthetic DMARDs (disease-modifying antirheumatic drugs) are strongly recommended for inadequate response to or intolerance of NSAIDs and/or intra-articular glucocorticoids for active TMJ arthritis 3, 1
Biologic DMARDs are conditionally recommended for inadequate response to or intolerance of NSAIDs, intra-articular glucocorticoids, and at least one conventional synthetic DMARD 3, 1

Proceeding to invasive procedures before exhausting conservative options 1, 4
Relying solely on occlusal splints despite limited evidence for their effectiveness 1
Performing irreversible procedures like permanent alterations to dentition or discectomy without clear indication 1, 2
Neglecting patient education about the condition and self-management strategies 1, 2
Repeated glucocorticoid injections in skeletally immature patients 3, 1
Using NSAIDs with opioids due to increased risks without clear additional benefits 1, 2